Abstract
Background: The extent to which benzonatate (Tessalon®), a structurally similar agent
to other local anesthetics including tetracaine and procaine, poses a risk to the
public is not fully appreciated as it is still one of the most widely prescribed antitussives
available. Objectives: To report a case of cardiac arrest with residual blindness
after Tessalon® overdose, review its clinical manifestations, toxicology and management
considerations, and describe the need for rational prescribing. Case Report: A 17-year-old
woman with no previous medical history presented to the Emergency Department (ED)
status post cardiac arrest. One to two hours prior, the patient had ingested at least
10 200-mg Tessalon® capsules as part of a suicide attempt. The patient was sedated,
intubated, and given magnesium as prophylaxis against recurrent dysrhythmias. Emergent
gastric lavage was performed and well tolerated. A 24-h hypothermia protocol with
6-h cooling period was initiated. Toxicological studies, chest radiograph, and a computed
tomography scan of the head were all unremarkable. The patient was admitted to the
Pediatric Intensive Care Unit for further work-up and supportive care. The patient
was extubated and able to follow some commands 1 week post-admission. The patient
developed blindness and experienced generalized confabulations, which did not resolve.
Conclusion: Ingestion of Tessalon®, a seemingly innocuous and widely prescribed antitussive,
may pose a risk to patients due to its potential for the rapid development of life-threatening
adverse events and limited treatment options in the overdose setting. Rational prescribing
and patient education is needed.
Keywords
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Article info
Publication history
Published online: November 06, 2009
Accepted:
August 29,
2009
Received in revised form:
July 14,
2009
Received:
May 22,
2009
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
